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By Chit Estella, Philippine Center of
Investigative Journalism
Conclusion
SMACK in the heart of downtown Manila and around
the Professional Regulatory Commission can be found the country’s
export processing zone for nurses. There, a dozen or so nursing
schools and training centers have somehow converged and are
thriving, mining the dreams of those aspiring to work overseas.
In one of these schools, students called upon to
recite are admonished by the teacher to speak in English. “How can
you work abroad if you can’t even answer in English?” the
teacher tells them.
Soon, the same school will also introduce a new
subject: Transcultural Nursing, which will teach students how to
practice their profession in countries whose culture and environment
differ vastly from the one they had always known.
Throughout the country, nursing education is
being retrofitted to meet the demands of the global market. A surge
in demand for nurses among health institutions
overseas—particularly in the United States and the United
Kingdom—is fueling a boom in nursing schools. But as in any other
boom, quality has suffered as the numbers increase, in large part
because of skewed priorities.
In the 1970s there were 40 nursing schools in
the country. Today there are about 350, including many that are
focusing more on reaping profits from people dreaming of
high-earning jobs overseas than on preparing students for an
exacting profession that provides care for ailing patients and
technical support for doctors.
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.
Yet instead of attending to these problems, 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.
But Rita Tamse of the Technical Committee on
Nursing Education of the Commission on Higher Education (CHED) urges
students to first scrutinize a school’s credentials and past
performance before parting with their often hefty tuition. She
notes, for instance, that 23 of the current number of nursing
schools have failed to meet the requirements set by the government
for them to operate. These schools are supposed to have until this
month to stop operating and start transferring their students, but
they have appealed to CHED to let them continue for one more year.
They have also sought the help of congressmen to avoid closure.
To help students avoid the duds among the
schools, CHED has issued a list showing the performance of various
schools in the Nursing Board Exam. CHED divided the schools into
five categories, with those that have 90 percent or more of their
examinees passing the Board in the last five years classifying as
institutions that had “outstanding performance.” The bottom
category is for “very low performing” schools, or those with 29
percent or below of their students passing the exams. (Check out
www.pcij.org for the list of schools.)
Very low performers made up 21 percent of the
total schools listed by CHED. The bulk, or 36 percent, of the total
belongs to the “low-performing” category, or schools that saw 30
percent to 49 percent of their students passing the Board.
Only 12 nursing schools—a mere 6 percent of
the total—made it to the outstanding category: University of the
Philippines-Manila, Saint Paul College (Iloilo), Silliman
University, Saint Louis University, Mindanao State University-Marawi
City, Saint Paul College (Dumaguete), Pamantasan ng Lungsod ng
Maynila, Saint Mary’s University (Bayombong), Saint Paul College
(Manila), and University of the East Ramon Magsaysay Memorial
Medical Center.
Of the 94 schools that had less than five years
of Board performance, 42 had zero passing rates, meaning none of
their graduates passed the national exam.
Under the law, a nursing school must have a
passing rate of 5 percent to be able to continue operating. CHED
wants to push the rate up to 30 percent, a level that could close
down many of the nursing schools.
To certain schools, CHED might appear to be a
villain. But the government and even recruiters know that in the
end, having high-quality graduates is the best way the country could
stay in the business of exporting nurses.
Requirements not being met
For almost a year CHED’s technical committee
monitored nursing schools for their compliance with five
requirements: adherence to the nursing curriculum, availability of
facilities, ratio of faculty to students, affiliation with or
existence of an active tertiary hospital to serve as base for
students, and a qualified faculty.
Tamse notes that many schools “are really
having trouble with the last three requirements.” 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.
A school must also have a dean—a requirement
that seems reasonable enough but which nursing schools find hard to
meet. “It’s very easy for them to have facilities because they
have lots of money,” says Tamse. “They can build a school, put
up air-conditioned classrooms, a nursing laboratory and all that.”
But one apparently cannot buy something that’s simply not
available, such as qualified teachers and a dean.
Base hospitals are also a problem. “We have
too many nursing schools for the number of qualified training
hospitals available all over the country,” says Tamse. Not just
any hospital can qualify as a base. It has to have the major
departments—surgical, obstetric-gynecological 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.
In addition, some schools want to offer classes
in trimesters or quartermesters, a suggestion that would fast-track
the course but inevitably lead to half-baked students. “In many
health sciences, exposure is important because that is where skills
are honed,” says the CHED consultant. “If you shorten that, you
come up with graduates who are half-baked. And when they get to the
hospitals to work, they’re dangerous. Talagang makakapatay [They
can really kill people].”
Diploma mills
The overwhelming number of students wanting to
become nurses obviously contributes to the desire of many schools to
have as many graduates as they can. According to CHED, nursing
schools had a total of 80,000 enrollees last year, among them
“second coursers.” The steep cost of the course apparently did
not faze them, perhaps because they expect a quick return in their
investment once they land a job overseas.
“Nursing is not a poor man’s course,”
admits a social science major, who has decided to change
professional gears. He ticks off his expenses: tuition per semester
is P40,000. Other costs include reading materials, about P5,000 (for
books, both bought and photocopied); stethoscope, P850; white shoes,
P1,500; white shoe polish, P500; food and lodging, P25,000.
For students who could not afford the full
semestral payment, an installment plan is available. A down payment
of P10,000 is required, with the balance paid in three “gives,”
each to be given before the three major tests: prelims, midterm and
finals. Inability to pay at any point would mean dropping out from
class, repeating the semester and paying up once more. In the end,
the poorer the student, the higher the costs incurred.
There are already schools that turn down
enrollees for sheer inability to accommodate them. Far Eastern
University, for example, reportedly rejected 5,000 applicants last
year. In the same period, the UP College of Nursing admitted only 70
students out of 11,000 who applied. That number for admission will
not increase even as 14,000 applicants have already asked to be
taken in for the coming school year.
No to second-coursers
At the same time, some nursing schools do not
admit second-coursers, including doctors, in their classes. The
demand from regular students appears to be enough to make up for any
financial gain that is given up.
Dr. Rusty Francisco, a nurse with a doctorate in
nursing education and an owner of a training center for nurses bound
for abroad, says many students are deluded into thinking that
enrollment in a nursing school is a guaranteed passport to a job
abroad.
“Passing all examinations does not make them
competitive,” he says. Not many Filipino nurses are familiar with
the medical equipment being used in US hospitals, he points out.
Neither do they know how to operate in an environment where patients
are more assertive and aware of their rights. That is why in his
training center, Francisco emphasizes what Filipino nurses should
expect when they are in the United States.
He adds that while Filipinos are still the
preferred health workers, they may soon be facing stiff competition
from the Chinese and the Indians who have come to realize the
financial windfall from the export of nurses to developed countries.
Changing values of nurses
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.
Francisco argues that even a high-standard
school may not be able to change the mindset of those already
determined to earn dollars above anything else. “A school
curriculum,” he says, “does not automatically turn a person into
a caring, compassionate nurse with the ability to be assertive and
articulate.”
Tamse agrees with the observation. “Some of
them don’t even have the heart for it,” she says. “They’re
just there because they know it’s a good passport for going
abroad. . . . Nursing is about caring and being compassionate.
It’s difficult to be compassionate if your only purpose is to
earn.”
But it is also difficult to deny the validity of
the economic reason behind the decisions of many who leave. At the
Philippine General Hospital, says Tamse, “99 percent left because
they have to finance the schooling of their brothers and sisters,
the husband is unemployed or underemployed, the children need to be
given quality education and so on.”
She says many of the nurses cry and tell her,
“I don’t want to leave naman ma’am, eh. It’s just that I
have to do it.” In one exit interview, a nurse underscored the
words, “Pera lang po [It’s only the money].”
But the likes of Tan are unwilling to take all
these sitting down. In a rather controversial scheme, Tan suggests
the enactment of a National Health Service Act that would require
health sciences education graduates of state colleges and
universities to serve the equivalent number of years of study in the
country. Since the state has subsidized the education of these
health science graduates, he reasons, they should pay back the favor
by serving in the country for a few years.
Pros and cons of mandatory service
Several bills have been filed in Congress
imposing mandatory service for nurses. Predictably, these have been
opposed by nurses’ organizations that say the practice is
discriminatory and oppressive.
Tan believes otherwise. He points out that
the current health crisis warrants compulsory service by health
workers for a specified period. He also notes that countries
like Indonesia and Malaysia require their medical and health science
graduates to work in the country before going abroad. In fact, Tan
says, the Philippines is the only country in Southeast Asia that
does not have a National Health Service Act.
Dr. Irineo Bernardo of the Philippine Hospital
Association, for his part, says, “We need to look at a problem
from many angles.” Instead of dreading the loss of more nurses,
doctors and other health workers, he suggests working harder to
improve the health condition of Filipinos.
“The government keeps talking about having a
strong republic,” he says. “Why not have healthy Filipinos so we
can really have a strong country?”
The country’s health status
Up to now, Bernardo says, the government has not
established the health status of the country. “How healthy or how
sick are we?” he asks. “If the number of health providers goes
down, will that make more people sick? No!”
But if the government fails to look after the
health of its people—such as by making it easy for cigarette
companies to sell their products—then Filipinos will get sick, he
says. Educating the people on how to take care of themselves could
do more to improve public health rather than having a big number of
health providers, he says. Points out Bernardo: “Sickness comes
from our lifestyle, from what we take in. We need food, not
medicine.”
Although the disappearance of doctors and nurses
is indeed a problem, Bernardo suggests taking good care of those who
stay behind. “Recognize the competence of nurse anesthetists, for
example, and pay them as well as a doctor,” he says. After
all, surgery would be impossible if no anesthesia is administered.
There is in fact a boon for those who will
remain in the country: they would now have a bigger market for
themselves, since they will have fewer rivals. “There will come a
time when things will not be good,” concedes Bernardo. “But they
will become better. Many hospitals will close down but they will be
replaced by new players. We will change.”
Part 1 |
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