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Protecting
a Legacy
Editorial:
March 2006 PNA-NY Newsletter
Clemencia
S. Wong, MA, RN
The convention in Honolulu, Hawaii in January
this year of the Philippine Nursing Association
- Phil. ( PNA-Phil.) and the Philippine Nurses
Association of America (PNAA ) was an uplifting
experience for me.. After my June 2005 trip to
the Philippines, I felt and saw firsthand the
effects of the exodus not only of the brain and
brawn out of the Philippines, but more importantly
the drain of the human spirit, mine included.
My
spirit was uplifted by the optimism presented
by the PNA-Phil. speakers and the delegation (all
42 of them!). While the important statistics presented
were grim that brought tears to many of us in
the audience, the speakers focused on the solutions,
rather on the seemingly unfathomable pit the country
has gotten into. Ruth Padilla, the past president
of PNA-Phil. reminded us that we have a "legacy
to protect: that Filipino nurses are world class"
- Yes, indeed! Joseph Burger of the New York Times
wrote that one of the reasons we came to dominate
the nursing field is because of our English language
skills and our education. Nursing education is
key to this legacy and it is threatened.
Nursing Education in the Philippines
This year marks the 100th year of nursing education
in the Philippines . It was pioneered by Dr. and
Mrs. Andrew Hall, Presbyterian missionaries at
the Union Mission Hospital in Iloilo. Through
the years, it has earned a reputation for excellence.
Although it was based on American nursing curriculum,
it is "never a mirror image reproduction"
according to Catherine Ceniza Choy .The Philippine
schools / colleges of nursing made adaptations
in its curriculum to reflect the needs of its
patients. Moreover, the Philippines is one of
eight countries in the world (the others are Canada,
Sweden, Portugal, Brazil, Iceland, Korea, and
Greece ) which require a four year undergraduate
education in order to practice nursing. Its admission
standards have always been high. Its graduates
are admitted to the best graduate schools in the
US, made contributions in nursing research, education
and administration. It also produced a president
of the International Council of Nurses (ICN) in
the person of Dean Julita Sotejo, founder of the
UP College of Nursing. Most importantly, it has
produced nurses at the bedside that have established
a reputation of "hard work, dedication and
competence". But that maybe changing if the
present trend in nursing education continues.
The predicted global nursing shortage and the
present socio-political-economic situation in
the Philippines combined to present like a "perfect
storm" to cause just everyone to want to
become a nurse and work abroad. As a result of
this demand for nurses, nursing schools sprouted
like mushrooms. There were only 70 schools/colleges
of nursing in 1973 (M.Lorenzo), 170 in 1999 and
by 2005, there are 470 (Galvez Tan). Some of these
schools are accelerated programs for the "second
degree holders", many of whom are physicians.
This proliferation of second rate schools which
opened more for profit than education is beginning
to take its toll. Annabelle Boromeo, RN, PhD quoted
Meladee Stankus, president of Nurse Immigration,USA
who says " we have seen a decrease in the
quality of nursing graduates from the Philippines,
not just in the facility in the English language
, but more so in critical thinking, assessment,
prioritizing, and clinical skills"
Borromeo, in her article, "Endangered"
discussed the indicators showing decline in the
quality of nursing education: the low passing
rates in the licensure examination, the substandard
quality of nursing instructors, inadequate number
of qualified training hospitals and the high attrition
rates in nursing schools.
Data
from the Professional Regulatory Commission (PRC)
show that the passing rate in the nursing board
examination declined from 61% in 1994 to 52% in
2005 and as low as 45% in 2002. I was told that
the" nurse medics" have a 100% passing
and that these numbers would have been lower,
were it not for them.
There
is also a shortage of qualified nursing faculty.
They too have left the country. This led to a
phenomenon of "flying deans and flying faculty
members". Those who are teaching are new
graduates without any clinical experience. This
practice, however, is not new and has been going
on for years.
There
are not enough hospitals that meet DOH standard
to provide clinical experience for the students,
according to Dr. Borromeo. Consequently, many
patients can have as many as 4-5 students in one
shift, taking care of them. As a result, the number
of schools that may affiliate with a hospital
is now regulated. However, these new regulations
have given rise to new problems because they have
not deterred astute business people in the nursing
school business to find creative ways to compete
for access to these facilities.
The attrition rate is high (67% in 1995-1999 and
89% in 2000-2003) and the percentage of those
graduating has been steadily decreasing according
to Dr. Borromeo. It just proves that one needs
to have the aptitude for nursing to graduate.
And then, one has to ask if the main criterion
for admission is the willingness to pay. In spite
of this, the number of examinees for the nursing
board doubled from 25,294 in2004 to 50.280 in
2005 .
National and International Response
So what is the Philippine government doing? It
has taken a position that immigration in pursuit
of a better life and professional fulfillment
is a right of all Filipinos. In 2001, when the
US announced the nursing shortage, Philippine
President Gloria Macapagal-Arroyo announced government
initiatives to "ensure the production of
top-notch nurses who will have an easier time
getting jobs overseas". The Commission on
Higher Education (CHED issued a memorandum on
"Guidelines to be followed in the admission
of professionals entering the nursing program"
In October 2002, THE PHILIPPINE NURSING ACT OF
1991 was repealed, an act providing for a more
responsive nursing profession. Due to the unabated
rise in the number of nursing schools, CHE) declared
a moratorium on the opening of new schools, part
of the nursing development plan to address the
issue of quality of nursing education.. In my
interview with Marilyn Lorenzo, RN, Ph.D , she
said that "this was probably the best thing
the government did" . This way, the Technical
Committee for Nursing Education which she chairs
can concentrate on monitoring and regulating the
schools that are open. It also decertified 23
nursing schools in the same year. She continued,
that in 2006, it will recommend closure of some
accelerated programs and there are other plans
: to weed out non-performing programs (schools
with passing rate of 30% or less), to develop
quality education programs including training
of deans and faculty , to influence the development
of advanced practice nursing and development of
the National Nursing Aptitude Test(NNAT).In April
2005, CHED and PRC has also published the top
20 best and 20 worst nursing schools based on
the percentage of passing in the nursing board
exams., for everyone to see. There is also a requirement
to do service for two years before going abroad
effective 2009. This requirement delays the departure
of the nurse and allows them to improve their
clinical skills, thus increasing their chance
of success to practice nursing abroad..Needless
to say, Dr. Lorenzo's group are up against the
same forces that have brought down every institutions
in the Philippines.
In 2005, ICN's Issue Paper 5, "International
Migration of Nurses: trends and policy implications,
of which Dr. Lorenzo is one of its authors, noted
that little is known about the experiences of
nurses working in destination countries in terms
of profile, future career plans and equality of
treatment and need for donor countries to support
and strengthen professional nurse association
to advocate for its members, It recommends research
and evaluation of good and poor practices in the
treatment of migrant nurses Moreover, it also
calls for systematic assessment of the various
models of managed migration such as bilateral
agreements, ethical codes in nursing recruitment,
return migrant schemes, and possible models of
"training for export"
As
a profession and as individual nurses, we are
living at a crucial time in history. We can bemoan
the nursing crisis, at how greed and mismanagement
in the Philippines is showing its ugly head in
corrupting the last bastion of respectability,
that is the image of a Filipino nurse. But as
we do, we can also move beyond that and ask ourselves
what can we do? Dr. Galvez Tan has some global,
Philippine-based and US-based strategies, many
of which emphasize the importance of having a
unified voice through PNA-Phil and /or in cooperation
with the PNAA.. Lobbying our elected representatives
in Congress and our state officials for more ethical
recruitment policies in hiring foreign nurses
, be a "balik bayani" by sharing our
expertise, are two examples.
There
must also be a way to connect nurses coming to
the United States to a state chapter of PNA so
they can have some support. It is also a way to
have access to the different contracts offered
to them and collect data on how they are treated
once they are here. The goal is to have input
on the provisions of these contracts and eventually
create a list of the agencies we can recommend
and those they need to avoid. This is not the
job of one PNA chapter, rather a cooperative endeavor
between the PNAA , the US and the Philippine governments.
We
have to support and salute the real heroes who
stayed behind. After all, protecting a legacy
is not just a national governmental responsibility,
but in the end our individual and collective responsibility
as well..
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